Healing of OralWounds

Question 1

1. Replacement of lost tissue by ______ tissue is known as repair.
   (a) Connective
   (b) Granulation
   (c) Epithelial
   (d) Vascular

Answer 1

1. (b) Healing refers to replacement of destroyed tissue by living
   tissue. When lost tissue is replaced by granulation tissue,
   the phenomenon is called repair, which results in scarring.

Question 2

2. In human beings, regeneration is limited to epithelium and
   (a) Kidney
   (b) Brain
   (c) Liver
   (d) Heart

Answer 2

(c) In the human body, only epithelium and liver (to some
extent only) have the ability of regeneration which means
replacement of lost tissue by the same tissue, unlike the
scar/granulation tissue that forms in repair.

Question 3

5. Suggest a suitable biopsy technique for a hard, bony lesion with
   a large lumen
   (a) Excisional biopsy
   (b) Punch biopsy
   (c) Fine needle aspiration biopsy
   (d) Incisional biopsy

Answer 3

(c) This biopsy is done with a fine needle attached to a syringe.
The needle is inserted into the lesion and then vacuum is
created so that tissue samples are sucked into the syringe.
The sample is used to prepare a smear and observed under
microscope

Question 4

3. All except one of the following conditions significantly affect the
   healing process
   (a) Diabetes mellitus (b) Beriberi
   (c) Scurvy (d) Heavy doses of X-rays

Answer 4

(b) Healing depends on many factors, among which some
important factors are vitamin C (role in collagen synthesis),
diabetes mellitus (probably related to disturbance in
carbohydrate metabolism) and X-rays (affects sensitive
undifferentiated mesenchymal cells).

Question 5

4. Which type of biopsy also serves as a treatment option?
   (a) Punch biopsy
   (b) Incisional biopsy
   (c) Fine needle aspiration biopsy
   (d) Excisional biopsy

Answer 5

(d) Total excision of small lesions for histologic study is called
excisional biopsy. It is preferred when size of lesion is small
and can be removed with margins of normal tissue and
wound can be closed properly.

Question 6

6. The most preferred instrument for small, soft, oral lesions is
   (a) Scalpel
   (b) Cautery
   (c) Needle
   (d) Biopsy punch

Answer 6

(a) Scalpel is the instrument of choice as it cleanly removes
tissues and does not dehydrate the tissue like a cautery.
Needle biopsy has little value in diagnosis of oral lesions

Question 7

7. Immediately after removal of the biopsied specimen, it must be
   fixed in ______ percent formalin.
   (a) 10
   (b) 100
   (c) 50
   (d) 75

Answer 7

(a) All tissues, if they are to be studied under a microscope need
to be “fixed” or preserved. For this purpose 10% neutral
buffered formalin is preferred. Formalin fixes and stabilizes
the tissues by cross-linking of proteins.

Question 8

8. Healing by primary intention is that type of healing which occurs
   when
   (a) It occurs within 72 hours
   (b) It is filled in by keloid
   (c) It is followed by significant loss of tissue
   (d) The edges of the wound are closely approximated

Answer 8

(d) Healing by primary intention usually occurs in tissues which
can be approximated closely together and sutured and is
commonly seen in clean, linear incisions which leave a
minimal linear scar.

Question 9

9. After the edges of the wound have been approximated and
   sutured, the first cells to reach the site of wound are
   (a) Fibroblasts
   (b) Leukocytes
   (c) Epithelial cells
   (d) RBCs

Answer 9

(b) Healing of tissues is considered to be an inflammatory process
since it cannot be separated from the previous vascular and
cellular phenomenon occurring in response to injury. Thus,
like in inflammatory response, the leukocytes are the first cell
to reach the wound site owing to the process of migration
mediated by chemicals called chemotaxis

Question 10

10. The stimulus for differentiation of new fibroblasts is provided
    through cytokines liberated by
    (a) Mast cells
    (b) Plasma cells
    (c) Epithelial cells
    (d) Macrophages

Answer 10

(d) Macrophages liberate cytokines like fibroblast growth
factor and transforming growth factor which mediates the
fibroblast activity

Question 11

11. Healing of which of the following regions in oral cavity is most
    likely to occur by secondary intention?
    (a) Labial mucosa
    (b) Buccal mucosa
    (c) Vestibule
    (d) Hard palate

Answer 11

(d) Healing by secondary intention occurs when there is tissue
loss and when the edges of the wound cannot be brought
together. Thus, since the edges of wound on hard palate
cannot be approximated together owing to its fixed nature,
the wounds of hard palate gape and heal by secondary
intention.

Question 12

12. The most frequently employed fixative for fixing the collected
    material for exfoliative cytology on a glass microscopic slide is
    (a) Formaldehyde
    (b) 95 percent alcohol
    (c) Glutaraldehyde
    (d) Mercuric chloride

Answer 12

(b) 95% alcohol is the most preferred fixative in exfoliative
cytology technique. It works by denaturing the proteins
by coagulating them. It is important to remember that the
slides fixed by alcohol are left to air dry and should not be
heat fixed over a flame.

Question 13

13. Exfoliative cytology is not indicated in which of the following
    lesions?
    (a) Fibroma
    (b) Squamous cell carcinoma
    (c) Pemphigus vulgaris
    (d) Sickle cell anemia

Answer 13

(a) Lesions like fibromas which have an intact and a normal
surface do not lend themselves very well for exfoliative
cytology

Question 14

14. The organization of clot in gingivectomy wounds usually occurs
    by ______ days.
    (a) 15–20
    (b) 8–10
    (c) 2–4
    (d) 1–2

Answer 14

(b) Healing process in gingivectomy continues by condensation of the young connective tissue (granulation tissue)
and almost complete organization of the clot within
8–10 days

Question 14

15. Epithelialization of a gingivectomy wound is usually complete
    by ______ days.
    (a) 1–2
    (b) 3–5
    (c) 10–14
    (d) 15–20

Answer 14

(c) Epithelialization of a gingivectomy wound occurs in the
late healing phase and is usually complete by 10–14 days.
However, at this stage, the epithelium is weak and form rete
ridges only two weeks later.

Question 15

16. Healing of which region of gingiva is the slowest?
    (a) Free gingiva
    (b) Attached gingiva
    (c) Interdental gingiva
    (d) Gingival sulcus

Answer 15

(c) Healing in interdental gingiva is slower than other regions
of gingiva probably because epithelium covering the
interdental regions must grow in from the facial and lingual
areas which is a relatively great distance to cover

Question 16

17. The surface of the blood clot 24–48 hours after tooth extraction
    is covered by
    (a) Fibrin
    (b) Prothrombin
    (c) Epithelial cells
    (d) Collagen fibers

Answer 16

(a) Within 24–48 hours of extraction there is dilatation and
engorgement of blood vessels in the area surrounding extraction site as well as migration of PMNLs. The surface
of clot is covered by a thick layer of fibrin at this stage.

Question 17

18. Organization of the clot in an extraction wound occurs by
    (a) Epithelial cells growing into the clot
    (b) Fibroblasts growing into the clot
    (c) Contraction of the clot
    (d) Blood vessels growing into the clot

Answer 17

(b) In the first week following extraction, the blood clot
organizes primarily due to ingrowth of fibroblasts from the
periphery of extraction site and occasional small capillaries
from the residual PDL.

Question 17

19. Young trabeculae of new, woven bone make their appearance
    within the organizing clot in an extraction wound by ______ week.
    (a) 1st
    (b) 4th
    (c) 9th
    (d) 3rd

Answer 17

(d) As healing of extraction site enters third week, the original
blood clot is almost completely organized by the maturing
granulation tissue. At this time, immature trabeculae
of osteoid can be seen forming around the periphery of
wound from the wall of the socket. This early, woven bone is
formed by the osteoblasts derived from the undifferentiated
ectomesenchymal cells of the residual PDL which now
assumes an osteogenic function.

Question 18

20. Dry socket/alveolitis sicca is essentially a
    (a) Acute osteomyelitis
    (b) Chronic osteomyelitis
    (c) Garé osteomyelitis
    (d) Focal osteomyelitis

Answer 18

(d) Alveolitis sicca or dry socket is the most common
complication in the healing of extraction wounds. It is a
type of focal osteomyelitis in which the blood clot has been
dislodged or has disintegrated, with production of foul odor
and sever throbbing pain, but there is no pus formation.

Question 19

22. Extraction of which of the following teeth is most likely to result
    in dry socket?
    (a) Extraction of mobile maxillary incisors
    (b) Extraction of firm mandibular incisors
    (c) Extraction of impacted mandibular 3rd molars
    (d) Extraction of firm maxillary canines

Answer 19

(c) Dry socket is most frequently encountered after a traumatic
or difficult extraction. Therefore, the single most important
factor in prevention of postextraction complications is
gentleness in handling living tissues.

Question 19

21. Which of the following sign/symptom is not encountered in dry
    socket?
    (a) Suppuration
    (b) Pain
    (c) Foul smell
    (d) Exposure of bone

Answer 19

(a) The primary signs and symptoms in dry socket are severe
throbbing pain and foul smell. These are due to proteolytic
enzymes produced by bacteria or local fibrinolytic activity.
However, there is no suppuration, but there may be necrosis
of bone which may gradually sequestrate in small pieces.

Question 20

23. Which of the following clinical settings is least likely to result in
    dry socket?
    (a) Fracture of a tooth during extraction
    (b) Patients suffering from Paget’s disease
    (c) Extraction of a mobile maxillary incisor
    (d) Patients undergoing radiotherapy

Answer 20

(c) Paget’s disease of bones, radiotherapy and traumatic
extractions are principal factors which can predispose a
patient to the development of dry socket post-extraction.
Extraction of a mobile tooth is not considered a traumatic
procedure that can lead to dry socket.

Question 21

24. The newly forming bone at the site of fracture is called
    (a) Woven bone
    (b) Callus
    (c) Spongy bone
    (d) Immature bone

Answer 21

(b) Callus (Latin—overgrowth of hard skin) unites the fractured
ends of bones and is composed of varying amounts of
fibrous tissue, cartilage and bone. It has two parts external,
made of new tissue that forms outside the two fragments
of bone and internal, made of new tissue arising from the
marrow cavity

Question 22

25. Which structure of bone is most important during callus
    formation?
    (a) Periosteum
    (b) Epiphysis
    (c) Endosteum
    (d) Metaphysis

Answer 22

(a) Preservation of periosteum is essential for proper union of
fractured bone fragments because the cells in its inner layer assume the features of osteoblasts and form a layer called
callus over and around the surface of fracture.

Question 23

26. Replantation refers to
    (a) Insertion of vital/nonvital tooth into same socket
    (b) Insertion of vital tooth into another socket of same person
    (c) Insertion of nonvital tooth into another person’s socket
    (d) Surgical removal of an implant and placement into another
    location

Answer 23

(a) This procedure is most commonly used after a tooth is
avulsed either due to traumatic injuries or other accidental
loss of tooth

Question 24

27. When a tooth is avulsed, it is important to reduce the extraoral
    time in order to
    (a) Keep the neurovascular bundle intact
    (b) Keep the cells of PDL in a viable state
    (c) Prevent dehydration of external tooth surfaces
    (d) Prevent bacterial contamination of exposed tooth surfaces

Answer 24

(b) Replantation of at least the partially formed teeth may be
followed by re-establishment of normal PDL space primarily
brought about by the remaining viable cells of PDL attached
to the root surfaces. Even some mature, fully formed teeth
show partial establishment of PDL space if the cells are kept
in a viable state.

Question 25

28. In the course of time, many of the replanted teeth result in
    (a) Gomphosis
    (b) Ankylosis and root resorption
    (c) Fibrosis
    (d) Epithelialization

Answer 25

(b) Replantation of mature, fully formed teeth is usually
followed by ankylosis and resorption of root/roots. This is
generally seen even after the periodontal tissues attached
to the root of replanted tooth are preserved.

Question 26

29. Most commonly, a damaged permanent mandibular first molar
    is transplanted by
    (a) Developing third molar
    (b) Osseointegrated implant
    (c) Developing second molar
    (d) Developing first molar

Answer 26

(a) Transplantation finds it greatest use in replacement of teeth
damaged beyond repair by caries. If the transplanted tooth
is of the same person it is called autotransplant and if it is
from another person, allotransplant.

Question 27

30. All except ___________ are complications of wound healing.
    (a) Keloid/hypertrophic scar
    (b) Pigmentary changes
    (c) Infection
    (d) Callus

Answer 27

(d) Infection, keloid, hypertrophic scar tissue formation,
pigmentary changes, cicatrization, implantation cysts are
all complications of wound healing while callus formation
is a physiological phenomenon that brings about the union
of fractured ends of bones.